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Crisis Work in Behavioral Health: Building Self Efficacy and Preventing Burnout in Emergency Settings with Dr. Ellen Dotas, Part 2 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  Speaker 1: Hello and welcome to Mind and Medicine A Sentara Terra Podcast.
• 0:03
  Speaker 1: I'm Tommy Bateman, your host, and today we are continuing our talk on burnout and crisis work with Dr.
• 0:08
  Speaker 1: Ellen Dotas.
• 0:09
  Speaker 1: Before we begin, here are a few important CME announcements.
• 0:12
  Speaker 1: This episode is accredited for AMA PRA Category 1 credits for full accreditation, designation, and disclosure information.
• 0:19
  Speaker 1: Please refer to the show notes and now the show.
• 0:23
  Speaker 1: Thank you and welcome back, Ellen.
• 0:26
  Speaker 1: So where we left off last time was talking about how individuals working in the crisis mental health world are making very tough decisions that have consequences for their career, their agency, and of course the clients that they're dealing with.
• 0:42
  Speaker 1: So I have a feeling uh that burnout is a pretty high risk here.
• 0:46
  Speaker 1: Am I wrong?
• 0:48
  Speaker: It's you're not wrong because I mean it's yeah, it is a it's a it's a situation where you don't want to make the wrong decision.
• 0:56
  Speaker: But um I think any kind of crisis work, you it it's all about kind of your checks and balances along the way.
• 1:03
  Speaker: It's like they don't just, you wouldn't just take somebody new at the CSB and say, here, go out and see this patient and whatever you think is fine.
• 1:10
  Speaker: Um they, you know, people starting there, they start with a with training, they have to get certified as a pre-screener, they have to shadow people, then people have to shadow them.
• 1:21
  Speaker: And it's the same thing in our and in the private hospitals that we we try to get a lot of training in first, and we wouldn't put somebody out on their own until we knew that they were comfortable with, you know, and felt felt confident enough to do something by themselves.
• 1:36
  Speaker: And even then we would be checking to make sure that the decisions were were supported.
• 1:42
  Speaker 1: So let's get more granular.
• 1:43
  Speaker 1: What specifically within crisis work can lead uh one to a higher risk of burnout?
• 1:49
  Speaker: Things that can lead to burnout is things like I guess kind of the secondary trauma that well, first off, somebody wouldn't go into this line of work, hopefully, unless this is really where their passion was.
• 2:02
  Speaker: You know, if you were somebody that wanted uh private practice, very, you know, stable, the consistency of seeing your patients or your clients week after week, working on you know, long-term relationships, this is not the thing, you know, because you might see these people once, and that's that's that.
• 2:20
  Speaker: It's it's a totally different vibe, it's a different pace.
• 2:23
  Speaker: And that's you have to first like that.
• 2:25
  Speaker: So, but the things that can lead to burnout is just, you know, you work crazy hours sometimes.
• 2:32
  Speaker: Um, there is the secondary trauma that, you know, every day you're going in and people are in one kind of crisis after another.
• 2:40
  Speaker: They might be um suicidal, they're dealing with a lot of loss, relationship issues.
• 2:46
  Speaker: Sometimes they want to harm other people, sometimes they're just angry at everybody and you know, and are taking it out on you because you're the person trying to talk to them.
• 2:55
  Speaker: Um, there's also, I think, some kind sometimes kind of compassion fatigue that it's just just like long-term caregivers, you just are doing that it's this emotional exhaustion that builds up.
• 3:06
  Speaker: So I think there's a lot of things that can contribute to it.
• 3:09
  Speaker 1: So I'm hearing we have burnout, and then we have the concept of secondary trauma, which you know can feed into one another, but they're distinct.
• 3:18
  Speaker 1: You can be one without the other.
• 3:20
  Speaker 1: And then we have, you know, compassion fatigue as well.
• 3:23
  Speaker 1: Is there a way we can distinguish between the three?
• 3:27
  Speaker: And I think that compassion fatigue is more is closer to burnout, you know, that it's uh you're just feeling a lot of emotional exhaustion, and at some point it turns into some kind of decreased level of empathy that you're just I just I'm full, I can't take anymore.
• 3:42
  Speaker: Um and so that leads to more burnout.
• 3:45
  Speaker: Secondary trauma is more um, I think akin to like a PTSD type of symptom that you know that it's just you've you've heard these so many stories and it's starting to kind of you know build up that you just have to you're affected by it.
• 4:02
  Speaker: Um and so I think you just have to learn if you want to keep doing this and not burn out, then it's like what can you do?
• 4:10
  Speaker: What kind of skills can you learn on the other side to take care of yourself?
• 4:13
  Speaker: And I think those are those are important things to keep in mind.
• 4:18
  Speaker 1: Awesome.
• 4:18
  Speaker 1: Thanks for clarifying.
• 4:19
  Speaker 1: And that leads me to wonder when does somebody know that they're burnt out?
• 4:23
  Speaker 1: You know, in this job, you can just go, go, go because you know that there are people in systems depending on you.
• 4:30
  Speaker 1: When can somebody kind of take up, come up for a breath of fresh air and go, hey, wait a minute, am I burnt out?
• 4:38
  Speaker: I mean, I think everybody kind of gets to that point when you know it's just like, I can't, you know, I just can't keep going at this pace, or I just can't, or you start noticing that I'm not quite myself, you know, I that level of empathy is not quite there, or I just yeah, it just something does starts to feel off.
• 4:56
  Speaker: I think that a lot of, or maybe your friends are telling you, yeah, you dude, you're not yourself right now.
• 5:01
  Speaker: Um I think I think there are those kind of indicators, but um maybe just stopping sometimes and reflecting on what what am I doing to take care of myself.
• 5:12
  Speaker: I mean, and this is whether you're in a crisis job, whether you're um in, you know, in your home life, in another type of job, it's like you have to figure out what what am I doing to take care of myself as well, and that I can't always put myself last on the list.
• 5:26
  Speaker: You if your stress level is high, your self-celler care level should be um as high as you can make it at that time, too, just to balance them out.
• 5:36
  Speaker 1: So you mentioned self-care, but what are some other ways to help prevent burnout or at least deal with it when it comes?
• 5:44
  Speaker: I th um knowing who your supports are, it's like if something was really um really challenging, who can you go to to just kind of debrief on that or just process it?
• 5:55
  Speaker: I think that's that's oftentimes very helpful.
• 5:58
  Speaker: I think as a counselor, boundary setting is is a good thing, not not just with your clients, but also for yourself.
• 6:06
  Speaker: That you hear about people all the time that um oh, I I give my clients my my personal phone number or something so I know that they they can reach me if they need to.
• 6:15
  Speaker: And uh that's their choice, but you know, it no, don't do that.
• 6:20
  Speaker: Same.
• 6:21
  Speaker 1: Yeah, and we we talk about the importance of boundaries with our clients and you know maintaining proper ethics, but also we need to think about, you know, practically speaking, professional boundaries that you know, when when thwarted, uh can lead to a lot of burnout issues as well.
• 6:37
  Speaker: That's one thing we've you know, we try to stress with new like with new new employees to them.
• 6:43
  Speaker: Somebody's a new into a crisis role.
• 6:45
  Speaker: Um, this is not the same as a therapy session and like in the community that I'm not gonna get as deep.
• 6:52
  Speaker: I want to know why you're here today.
• 6:54
  Speaker: So my I you know, right away that's a little bit limited.
• 6:57
  Speaker: What happened to you, you know, today?
• 6:59
  Speaker: What brought you in today?
• 7:00
  Speaker: And where do I need to get you for the next the next level of help that you need, whether that's going home, whether that's staying in the hospital or something else?
• 7:08
  Speaker: Um, figure that part out.
• 7:10
  Speaker: But the other piece is that when somebody leaves, where does my influence end?
• 7:15
  Speaker: You know, well, what if they go back home and get into another argument with someone?
• 7:19
  Speaker: I can't control what somebody does out there.
• 7:21
  Speaker: I mean, I can just do the best I can to make that decision about is this is this safe that they go home?
• 7:27
  Speaker: And are they going to be safe?
• 7:29
  Speaker: I don't know what's going to happen tomorrow, next week, or next month, but we can try to make sure we have as many resources and supports out there for them.
• 7:38
  Speaker 1: Oh man, and I know clinicians that have been in the situation where you know they made the best, the best choice they could with the information that they had, you know, if they had to release that client on a safety plan, because otherwise they were definitely trampling on that client's rights at that point.
• 7:54
  Speaker 1: And by release on safety plan, meaning, you know, not hospitalizing the individual.
• 7:58
  Speaker 1: And the next day or not long afterwards, there's some sort of tragic event.
• 8:05
  Speaker 1: Um but they did the best they could with what they had at that moment.
• 8:10
  Speaker: Hindsight's 2020.
• 8:11
  Speaker: Sure.
• 8:11
  Speaker: That's it, because um sometimes there's things we don't know.
• 8:15
  Speaker: So we just have to go back to not what I know today, but what did I know at that time and what were the facts that I could use to make my decision.
• 8:24
  Speaker 1: Um I've seen and I've experienced this folks that say, like, you know, geez, I've had this training and this experience, and not in an arrogant way, but in a way that says I should have been able to see it and know it like some sort of superpower.
• 8:39
  Speaker 1: And that's not really what this role is, right?
• 8:42
  Speaker: Right.
• 8:43
  Speaker: I think it's to to help people and to do make the best decision that we can given the facts that we have.
• 8:50
  Speaker: And you know, and sometimes we're also like you trust your feelings a little bit on that.
• 8:55
  Speaker: Like if I'm there's some I'm missing a piece here, then I need to keep asking questions or I need to keep finding out what I think is is not there, you know, just doing my due diligence as much as I can to find out uh what am I missing?
• 9:08
  Speaker: And then if and then I make the best decision that I can with the facts at hand.
• 9:14
  Speaker 1: So what is the role of an employer or organization when it comes to building self-efficacy and preventing burnout?
• 9:20
  Speaker 1: Is it a front and center thing?
• 9:22
  Speaker 1: Is it high priority?
• 9:23
  Speaker 1: Is it or is it just some sort of uh uh something that you need to continu continue to consider as support in the background?
• 9:32
  Speaker: I think I mean what the organization's responsibility is like we want to take care of our employees.
• 9:39
  Speaker: Every organization wants to have uh, you know, a good workforce and a happy workforce.
• 9:44
  Speaker: And and I think that the you have to be every organization should look at what the stressors they're they're facing and then figure out how they can support them.
• 9:54
  Speaker: I mean, if you don't have the support of your leadership, that's you know, that's a huge thing, you know, that um you have to you have to have that.
• 10:02
  Speaker: Um I think also what can we do?
• 10:05
  Speaker: Everybody, when I I asked that question when I was working on my dissertation, I'm like, what else do you need to to keep people here?
• 10:11
  Speaker: Because you see people leaving all the time.
• 10:12
  Speaker: And they were like, sometimes it's you know, yeah, sometimes it's the pay.
• 10:16
  Speaker: The the you know, what is my pay fair for what I'm doing?
• 10:20
  Speaker: Um, what are the hours that I'm working?
• 10:22
  Speaker: If people are working ridiculous hours, you can only do that for so long.
• 10:26
  Speaker: So um I think having the pulse on that and making sure that you're addressing those issues as best you can with your team is is really important.
• 10:36
  Speaker: And then just regret, you know, just recognizing that everybody needs um everybody needs some support from us in terms of you know becoming resilient and managing the, you know, just we need to provide the opportunities to help them help themselves.
• 10:52
  Speaker: I guess uh I don't know if that makes any sense, but you know, whether that's I like, you know, a meditation um period, uh you know, that or just to chant, make sure that you guys are taking breaks, um, any kind of supportive trainings on, you know, letting them know what's available, that what kind of support we have for them.
• 11:09
  Speaker 1: How would you structure that into your daily or weekly practice as an organization or supervisor?
• 11:15
  Speaker: Um, I know one thing here at Centera, they've had like on Wednesdays, they have a half an hour medication just for like self-care.
• 11:23
  Speaker: Um, they're doing that, I think, just in April and May, maybe.
• 11:26
  Speaker: But um, I think that's a helpful chance if people are able to do that.
• 11:30
  Speaker: Um we've been trying to on our team, just on our monthly staff meetings, talk about what do you do, have somebody just tell us a little bit about what do you do to to to relax?
• 11:41
  Speaker: What do you do?
• 11:42
  Speaker: You know, give us an idea.
• 11:43
  Speaker: It doesn't have to be something that everybody would do, but it, you know, just if you can find something that that would be fun.
• 11:49
  Speaker: Um I taught a crisis class a couple of years ago, and it was the the fun thing, it was for it was for like the CSPA students, the student personnel and student, you know, student affairs kids that were growing going into this field.
• 12:04
  Speaker: And we taught them all about mental health crisis.
• 12:07
  Speaker: And at first they were like even like, oh, you're gonna say the word suicide, you know, and we're like, yes, you know, you have you have to be able to have those talks with your students because you know they're gonna come into your offices.
• 12:16
  Speaker: So, and these kids weren't gonna be therapists, but they were gonna have this stuff if they worked in higher ed.
• 12:21
  Speaker: So we talked about this and got them through the semester and they built all their safety plans and they knew how to do all their different, you know, resources and things that they would need for their programs.
• 12:32
  Speaker: Um, but then at the end of the semester, after they had done their big project, we said, we want our last couple classes just to be about stress management, care for the caregiver, that when you have a really difficult thing happen on your campus, you know, how are you going to take care of yourself?
• 12:47
  Speaker: What do you do?
• 12:48
  Speaker: And so each each kid's assignment was 10 minute little demonstration of something you do to relax.
• 12:54
  Speaker: And it was the most fun that we'd had.
• 12:56
  Speaker: It was like they came in, they were doing um, you know, dance videos, somebody showed us how to, you know, do puzzles, somebody else showed us how to frost cupcakes, somebody else came in with Legos.
• 13:07
  Speaker: I mean, it was just anything that you wanted to do, just show us something fun that you do to relax.
• 13:12
  Speaker: You know, tell us about your workout routine.
• 13:14
  Speaker: You can do anything.
• 13:15
  Speaker: Um, and that's what we're trying to do too, to get our teams to do now is that just find ways to, you know, just to give somebody an idea of what they can do to relax.
• 13:25
  Speaker 1: Well, then along with encouraging self-care, uh, is it incumbent upon organizations to make sure that the chances of burnout are low?
• 13:35
  Speaker 1: For example, you know, ensuring that we have enough staff for the job so that our staff aren't spread so thin that they can't even come up for a breath of fresh air.
• 13:45
  Speaker: Absolutely.
• 13:46
  Speaker: I mean, when we have when we're short staffed, it's terrible because everybody's a lot of people in this work, they just have a really good work ethic.
• 13:53
  Speaker: So they don't want, you know, it's 24-7 work and they don't, they hate seeing I'm going off shift, but I see there's another X number of patients waiting to be seen.
• 14:03
  Speaker: Oh, you know, and you feel that stress kind of building up.
• 14:06
  Speaker: And we're like, nope, there's a boundary.
• 14:07
  Speaker: You're done.
• 14:08
  Speaker: This is the doors don't close here.
• 14:10
  Speaker: There's always going to be somebody waiting, but there's always going to be other people coming on.
• 14:13
  Speaker: So we try to work to make sure that we have a good staffing ratio and that we have people that can pitch in if you know, if needed, if something comes up and just give people that support.
• 14:24
  Speaker: The other thing is just when you have one of those crazy nights, you know, just recognizing that sometimes it, yes, it's it's not a substitute for getting a good night's sleep, but at least it's letting people know that, you know, we appreciate everything you did.
• 14:37
  Speaker: We appreciate all the the you know the extra effort you put in last night.
• 14:41
  Speaker: Um, I think just recognizing the work that people do, that's that can be meaningful to people um kind of in the in the short term there.
• 14:49
  Speaker: But then, yeah, and we're gonna try to do something to make sure that these nights are the exception, not the rule.
• 14:55
  Speaker 1: Yeah, and this this whole discussion right here kind of brings me back to part one where we were discussing how you know crisis work is often time the first stop or entry-level job for a lot of new clinicians out of grad school.
• 15:09
  Speaker 1: And you know, I wonder if we need to rethink that to where you know crisis is more of a specialty and that we have levels of competence.
• 15:19
  Speaker 1: You know, we have entry-level crisis worker all the way up to grizzled ultra crisis employee, supervisor, director.
• 15:26
  Speaker 1: So that way um, you know, we have more of a more of a continuum of competency.
• 15:35
  Speaker: Oh yeah.
• 15:36
  Speaker: I mean, I think there's I think there's always opportunities just to bring more people in.
• 15:41
  Speaker: I mean, I think college students, they don't always know what's out there when they graduate.
• 15:47
  Speaker: You know, that when they graduate, they think of, oh, I could get a job and I can be a therapist and I can have this cool office and I can, you know, help people and I just want to do things, you know, to help people.
• 15:57
  Speaker: And um, and they have a different, you know, they have an idea of what they want to do.
• 16:01
  Speaker: But then if they come in and they get to see something in the emergency room, they're like, oh, well, this is really cool.
• 16:06
  Speaker: I, you know, I'm kind of interested in this.
• 16:08
  Speaker: Sometimes they don't know all the wide variety of jobs that are available to them.
• 16:12
  Speaker: So I think in master's programs, getting to know, you know, getting more exposure, maybe through your part of an internship, that do, you know, do part of your internship in an emergency room or, you know, with a team like ours, um anything like that that gets you to see the whole spectrum of what's out there.
• 16:29
  Speaker: I think that that's helpful.
• 16:31
  Speaker: Um I don't know.
• 16:33
  Speaker: I I think I always felt like instead of crisis being this is what you put the new people new people in, and then they become therapists later, it's it's it's backwards.
• 16:42
  Speaker: It's just like, yes, you've you do you've had internships in your master's program where you were counseling another another student or something like that.
• 16:50
  Speaker: Everybody had to do that for their practicums and things like that.
• 16:52
  Speaker: So you've always already started on that a little bit, but you know, then where do those people send their clients if they get to, if they're in a crisis?
• 17:02
  Speaker: You send them over to the crisis clinicians.
• 17:04
  Speaker: So it's like when it's too much for the outpatient um setting, then they bring them over to the hospital.
• 17:09
  Speaker: So that's why I think they're it's it's almost kind of backwards.
• 17:12
  Speaker: That should be the person that has a little bit more experience in this.
• 17:14
  Speaker: But um, yeah, anything that we can do to help people develop that it by either workshops, classes, you know, just opportunities to practice that as a team and just the doing a risk assessment.
• 17:26
  Speaker: That's stuff that everybody should know how to do if you're in this field.
• 17:29
  Speaker 1: Agreed, agreed.
• 17:30
  Speaker 1: But Ellen, we're at time.
• 17:32
  Speaker 1: So do you have any partying warrants you want to share with the audience?
• 17:36
  Speaker: Just that.
• 17:36
  Speaker: I think that mental health is uh it's a very special field.
• 17:41
  Speaker: It's something that there's a lot of different people out there that do it, and everybody has their own vibe of what they what kind of work they like.
• 17:48
  Speaker: But um, emergency services and crisis work is really a rewarding part of that.
• 17:55
  Speaker 1: You've been listening to Mind and Medicine, a Sentera podcast.
• 17:58
  Speaker 1: As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode.
• 18:05
  Speaker 1: That's it for now, but keep an eye out for another episode and more evidence based education for healthcare providers on the go.
• 18:11
  Speaker 1: You well.